Small-size NSCLC: LNR boosts OS with wedge resection

  • Ding H & al.
  • Ann Thorac Surg
  • 22 Jan 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Lymph node resection (LNR) was associated with better OS in patients with NSCLC who underwent wedge resection for tumors ≤2 cm, but not segmentectomy.

Why this matters

  • The ideal target was 4-9 nodes for tumors ≤1 cm with wedge resection and 10 or more nodes for tumors 1-2 cm with wedge and segmentectomy.

Study design

  • 2864 patients with NSCLC from the SEER database with ≤2 cm tumors underwent wedge resection (n=2298) or segmentectomy (n=566).
  • Funding: None disclosed.

Key results

  • LNR was associated with better OS and lung cancer-specific survival (LCSS) with wedge resection, but not segmentectomy:
    • ≤1 cm OS: HR, 0.51; 95% CI, 0.35-0.76.
    • 1-2 cm OS: HR, 0.65; 95% CI, 0.54-0.76.
    • LCSS: HR 0.63; 95% CI, 0.50-0.79.
  • Patients with ≤1-cm tumors had better OS with 4-9 LNR (aHR, 0.29; 95% CI, 0.15-0.54) vs 1-3 nodes (aHR, 0.64; 95% CI, 0.42-0.96).
  • Patients with 1-2-cm tumors had better OS and LCSS with an increasing number of LNRs:
    • 1-3: OS aHR, 0.65 (95% CI, 0.54-0.78); LCSS aHR, 0.66 (95% CI, 0.51-0.86).
    • 4-9: OS aHR, 0.59 (95% CI, 0.46-0.75); LCSS aHR, 0.57 (95% CI, 0.40-0.80).
    • ≥10: OS aHR, 0.42 (95% CI, 0.28-0.63); LCSS aHR, 0.46 (95% CI, 0.27-0.77).

Limitations

  • Retrospective study.

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